MEDICARE: MYLENE GERONIMO APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	17034	CT

General Provider Information

NPI Number	:	1588462303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYLENE GERONIMO APRN

Provider Business Mailing Address
First Line	:	8 THOMAS WAITE DR
Second Line	:
City	:	OLD LYME
State	:	CT
Zip	:	06371-1546
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 THOMAS WAITE DR
Second Line	:
City	:	OLD LYME
State	:	CT
Zip	:	06371-1546
Country	:	US
Telephone Number	:	860-514-5286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2025
Last Update Date	:	04/10/2026

Similar Medicare Providers

1639419567 — DANIELLE G. MOREAU LMHC
Practice Location Address:

1546 OLD PLAINVILLE RD
DARTMOUTH, MA
02747-1408

Practice Phone: 508-287-7980
Practice Fax:

1114861879 — ASHLEY WILSON MS CCC-SLP
Practice Location Address:

4 HUNTLEY ROAD , SUITE 1
OLD LYME, CT
06371

Practice Phone: 860-245-8897
Practice Fax:

1841295490 — DAVID F ZITA PH.D.
Practice Location Address:

164 FOUR MILE RIVER RD
OLD LYME, CT
06371-1325

Practice Phone: 860-434-8284
Practice Fax:

1376540849 — DR. MARY CUMMINGS SATTI M.D.
Practice Location Address:

8 VISTA DR , EASTPORT NORTH BUSINESS PARK
OLD LYME, CT
06371-1537

Practice Phone: 860-434-8847
Practice Fax: 860-434-0428

1437149994 — OLD LYME SOUTH END VOLUNTEER AMBULANCE
Practice Location Address:

22 CROSS LN
OLD LYME, CT
06371-2115

Practice Phone: 860-434-0089
Practice Fax: 860-434-8052

1508849076 — MARY ELIZABETH GROTH A.P.R.N., P.M.H.S.
Practice Location Address:

59 LYME STREET
OLD LYME, CT
06371

Practice Phone: 860-373-6208
Practice Fax: 860-434-1580

Directions to “ MYLENE GERONIMO APRN” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.